Authors: Gauld, R
Reference: J Prim Health Care. 2018;10(1):6-10. doi.org/10.1071/HC17083
Summarised on: 27 June 2018
The author of this article argues that disruption is required to build health systems and a workforce for the future, rather than making adjustments to current service delivery arrangements.
The article acknowledges ageing populations, increasing chronic disease and multimorbidity as challenges to the health system. Ensuring that generalism and primary care are attractive professional choices, and retaining sufficient numbers of health professionals to meet patient demand are particular challenges.
The importance of integration, using best treatment evidence, and patient engagement are highlighted.
The author says the current institutional arrangements (ie rules and traditions) underpinning training and work organisation of health professionals provide limited capacity for responding to a health care delivery from patients’ point of view. The following three changes are needed:
- Workforce and care systems need to be redesigned for patients with multimorbidity.
- Workforce training structures should focus on inter-professionalism.
- Primary care should be shifted to the apex of the health professional hierarchy.
Key questions related to organisation for multimorbidity include whether one professional consultant is the lead provider of care and coordinates care for patients or whether a generalist or primary care doctor is the patient’s lead provider.
Beyond basic professional training, especially in medicine, the role of speciality colleges is critical. However, the model where colleges are separated along specialty lines fails in its ability to cross professional boundaries and limits considerations on how future patient care should be modelled and delivered. Thus, inter-professional training and the creation of team-based approaches to care delivery are vital.
Each profession’s role in the patients’ pathway through the health system should be clear and team work natural. The author argues that trainers have largely failed to transform design of curricula despite making a significant contribution to producing highly skilled and qualified graduates.
Finally, the author stresses the need for strong primary care in health systems and focusing on treating patients as close to their home as possible, in community locations.
However, this is constrained by the need for more primary care doctors and the challenges of their relatively low income compared with medical specialists; siloed medical curricula in many medical schools; expansion of medical technologies; and consequent expectation of graduates to progress keeping up-to-date with more about less rather than more about more.
The author argues that primary care doctors are the ultimate specialists because they must have a strong grasp of all conditions and medicines, and are deserving of the highest-status pedestal.
Therefore, professional colleges should consider how to reframe their relative positions in the medical hierarchy. He calls for consideration around rebalancing incomes in favour of general practice, and redesigning how primary care operates in the broader health system.